Development and validation of a machine learning model to predict cognitive behavioral therapy outcome in obsessive-compulsive disorder using clinical and neuroimaging data
Abstract
Cognitive behavioral therapy (CBT) is a first-line treatment for obsessive-compulsive disorder (OCD), but clinical response is difficult to predict. In this study, we aimed to develop predictive models using clinical and neuroimaging data from the multicenter Enhancing Neuro-Imaging and Genetics through Meta-Analysis (ENIGMA)-OCD consortium. Baseline clinical and resting-state functional magnetic imaging (rs-fMRI) data from 159 adult patients aged 18-60 years (88 female) with OCD who received CBT at four treatment/neuroimaging sites were included. Fractional amplitude of low frequency fluctuations, regional homogeneity and atlas-based functional connectivity were computed. Clinical CBT response and remission were predicted using support vector machine and random forest classifiers on clinical data only, rs-fMRI data only, and the combination of both clinical and rs-fMRI data. The use of only clinical data yielded an area under the ROC curve (AUC) of 0.69 for predicting remission (p=0.001). Lower baseline symptom severity, younger age, an absence of cleaning obsessions, unmedicated status, and higher education had the highest model impact in predicting remission. The best predictive performance using only rs-fMRI was obtained with regional homogeneity for remission (AUC=0.59). Predicting response with rsf-MRI generally did not exceed chance level. Machine learning models based on clinical data may thus hold promise in predicting remission after CBT for OCD, but the predictive power of multicenter rs-fMRI data is limited.
Authors 22
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Laurens A. van de Mortel corresponding
Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience
Affiliation as printed
Amsterdam Neuroscience, Amsterdam, The Netherlands
Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
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Willem B. Bruin Aachen Institute of Education and Child Studies Section Forensic Family & Youth Care
Leiden University · Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience
Affiliation as printed
Amsterdam Neuroscience, Amsterdam, The Netherlands
Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
Leiden University, Institute of Education & Child Studies, Section Forensic Family & Youth Care, The Netherlands
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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Centre for Addiction and Mental Health · University of Toronto · Karolinska Institutet
Affiliation as printed
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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University of California San Diego
Affiliation as printed
Department of Radiology, University of California, San Diego, CA, USA
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Haukeland University Hospital · Molde Hospital
Affiliation as printed
Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
Psychiatric Department, Hospital of Molde, Molde, Norway
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Haukeland University Hospital · Senter for Krisepsykologi · University of Bergen
Affiliation as printed
Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
Centre for Crisis Psychology, University of Bergen, Bergen, Norway
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Haukeland University Hospital · Senter for Krisepsykologi · University of Bergen
Affiliation as printed
Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
Centre for Crisis Psychology, University of Bergen, Bergen, Norway
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
Radiology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
Department of Clinical Sciences, University of Barcelona, Barcelona, Spain
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University of California, Los Angeles
Affiliation as printed
Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA
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University of California, Los Angeles
Affiliation as printed
Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA
UCLA Brain Research Institute, University of California, Los Angeles, CA, USA
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University of California, Los Angeles
Affiliation as printed
Division of Child and Adolescent Psychiatry, Jane & Terry Semel Institute For Neurosciences, University of California, Los Angeles, CA, USA
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
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Bellvitge University Hospital · Institut d'Investigació Biomédica de Bellvitge · Centro de Investigación Biomédica en Red de Salud Mental · Universitat de Barcelona
Affiliation as printed
Bellvitge Biomedical Research Insitute-IDIBELL, Bellvitge University Hospital, Barcelona, Spain
CIBERSAM, Barcelona, Spain
Department of Social Psychology and Quantitative Psychology, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
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University of Southern California
Affiliation as printed
Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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South African Medical Research Council · University of Cape Town
Affiliation as printed
SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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University of Southern California
Affiliation as printed
Imaging Genetics Center, Stevens Neuroimaging & Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Amsterdam UMC Location Vrije Universiteit Amsterdam
Affiliation as printed
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Anatomy and Neurosciences, De Boelelaan 1117, Amsterdam, The Netherlands
Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Psychiatry, De Boelelaan 1117, Amsterdam, The Netherlands
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Amsterdam UMC Location University of Amsterdam · Amsterdam Neuroscience
Affiliation as printed
Amsterdam Neuroscience, Amsterdam, The Netherlands
Amsterdam UMC location University of Amsterdam, Department of Psychiatry, Meibergdreef 9, Amsterdam, The Netherlands
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